Fever and Rash

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Fever and Rash

• A Sick College Student

Lisa B. Goben Domain Terminology Project N409
Spring Duke University School of Nursing
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Fever and Rash

• Measles (rubeola) in the 21st century
• A clinical syndrome characterized by fever,
  malaise, coryza, cough, and rash. Death is rare,
  usually from pneumonia or encephalopathy.
• It is highly contagious and was once considered
  as inevitable as death and taxes.
• Because of aggressive vaccination programs in the
  U.S. starting in the late 1980s, case reports
  have fallen from 250,000 in 1990 to a provisional
  105 cases in 2003.

So a college kid walks into the ER
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Fever and Rash
4
Demographic Data
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Living Situation
Age
College Student

• Dormitory
• Apartment

Family Support

• Relative
• Mother

6
Biophysical Attributes
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Medical History

• Symptoms
• Past Medical History

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Symptoms

• Sick
• Achy
• Arthralgias
• Felt bad
• Headache
• Itching

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Past Medical History

• Medical Problems
• Immunization History
• Medication Use
• Tobacco Use

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Medication Use

• Alternative Medications
• Tetracycline
• Doxycycline
• Side effects
• Photosensitivity
• Illegal Drugs

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Vital Signs

• Temperature
• 39.0 Centigrade
• Fever
• Blood pressure
• Heart Rate
• Postural (links to Dehydration)
• Respiration Rate
• Oxygen Saturation

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Physical Exam

• Physical Signs
• Neck
• Nucal Rigidity
• Lymphadenopathy
• Skin
• Rash
• Face
• Acne
• Chest
• Stomach
• Thighs

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Physical Exam

• Psychosocial Exam
• Reexamining

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Laboratory Tests

• Blood Tests
• Complete Blood Count
• Mono Spot
• Antibodies
• Rubeola IgM (links to Public Health Concerns)
• Rubeola IgG
• Results
• Positive
• Negative
• Levels

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Medical Knowledge
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Medical Knowledge

• Medical Provider
• Nurse Practitioner
• Doctor
• Consultant
• Literature
• Dermatology Textbook
• On-line Resources

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Diagnosis
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Diagnosis

• Disease
• Differential
• Probability

The terrors of disease are always with
us. Thomas A. Dooley (1927-1961)
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Differential

• Allergic reaction
• or
• Infectious Disease

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Infectious Disease

• Measles
• Rubeola
• Atypical Measles
• Mononucleosis
• Meningitis
• Meningococcal rash

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Drug Allergic Reaction
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Measles Rash
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Mononucleosis Rash
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Infectious Disease

• Non-specific Viral Illness
• Viral Syndrome
• Influenza A
• Influenza B
• Garbage Pail Diagnosis
• Viral Exanthem
• Contagious
• Public health concerns

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Disease

• Secondary Diagnosis
• Dehydration

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Treatment
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Intravenous Fluids

• Normal Saline

Medications

• Antipyretic
• -Tylenol

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Patient Teaching

• Explanation
• Patient Education
• Self Help
• Reassurance

Comfort measures

• Warm Blanket

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Outcome
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Discharged

• Called
• Resolved
• Sequelae

• Public Health Reporting

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Public Health Concerns
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Immunization

• MMR
• Immunity
• Wanes

Community Health

• Officials
• Outbreak
• Epidemic

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Take Home Message

• Common things are common
• Think horses not zebras
• Analysis improves patient care

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Bibliography

• Barinaga, J. L., Skolnik, P. R. (2005).
  Clinical presentation and diagnosis of measles,
  from http//uptodateonline.com.
• Charters, K. G. (2003). Nursing informatics,
  outcomes, and quality improvement. AACN Clinical
  Issues Advanced Practice in Acute Critical
  Care., 14(3), 282-294.
• Cohen, B. A., Lehmann, C. U. (2005).
  Dermatlas.Org, from http//dermatlas.med.jhmi.edu/
  derm/.
• Mengert, T., Eisenberg, M. S., Copass, M. K.
  (1996). Emergency medical therapy (4th ed.).
  Philadelphia W.B.Saunders.